| NPI | 1326024092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60246604) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036162736) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2023-01-19 |